Abemaciclib Plus Fulvestrant in Advanced Breast Cancer After Progression on CDK4/6 Inhibition: Results From the Phase III postMONARCH Trial
Yet another combination to consider after CDK4/6i + ET in HR+ MBC!
Tailored Dose-Dense Versus Standard Adjuvant Chemotherapy for High-Risk Early Breast Cancer: End-of-Study Results of the Randomized PANTHER Trial
Author(s): Alexios Matikas, MD, PhD1,2; Volker Möbus, MD, PhD3; Richard Greil, MD, PhD4; Anne Andersson, MD, PhD5; Günther G. Steger, MD6; Michael Untch, MD, PhD7; Tommy Fornander, MD, PhD1; Per Malmström, MD, PhD8,9; Sabine Schmatloch, MD10; Mats Hellström, BSc2; Hemming Johansson, BSc1; Michael Gnant, MD, PhD11; Yvonne Brandberg, PhD1; Sibylle Loibl, MD, PhD12; Theodoros Foukakis, MD, PhD theodoros.foukakis@ki.se1,2; Jonas Bergh, MD, PhD1,2
Source: https://doi.org/10.1200/JCO.24.00178
Dr. Anjan Patel's Thoughts
Well done study showing a 20% decrease in recurrence risk when using dose dense therapy [EC]/D compared to conventional dose [FEC]/D. Sometimes it is worth it to push.
ABSTRACT
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.
Although dose-dense adjuvant chemotherapy administered once every 2 weeks leads to superior outcomes compared with standard regimens once every 3 weeks, the observed improvement is largely limited to studies using the suboptimal paclitaxel schedule once every 3 weeks as control. PANTHER is an international phase III trial which compared sequential epirubicin/cyclophosphamide and docetaxel administered either once every 2 or once every 3 weeks, with tailored dosing at the dose-dense schedule according to hematologic toxicity. In this end-of-study analysis, the median follow-up was 10.3 years. Compared with standard adjuvant chemotherapy, dose-dense treatment improved breast cancer recurrence-free survival (hazard ratio [HR], 0.80 [95% CI, 0.65 to 0.98]; P = .030), event-free survival (HR, 0.78 [95% CI, 0.65 to 0.94]; P = .009), and distant disease-free survival (HR, 0.79 [95% CI, 0.64 to 0.98]; P = .030) while the improvement in overall survival was not statistically significant (HR, 0.82 [95% CI, 0.65 to 1.04]; P = .109). To our knowledge, this is the first trial that confirms the benefit of a dose-dense regimen over a control regimen containing docetaxel once every 3 weeks.
Author Affiliations
1Oncology/Pathology Department, Karolinska Institutet, Stockholm, Sweden; 2Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden; 3Department of Medicine II, Hematology & Oncology, University of Frankfurt, Frankfurt, Germany; 43rd Medical Department, Paracelsus Medical University and Salzburg Cancer Research Institute, Cancer Cluster Salzburg and AGMT, Salzburg, Austria; 5Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden; 6Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria; 7Helios Klinikum Berlin-Buch, Berlin, Germany; 8Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; 9Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; 10Elisabeth Hospital, Kassel, Germany; 11Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; 12German Breast Group, Neu-Isenburg, GermanyRelated Articles
Axillary Surgery in Breast Cancer — Primary Results of the INSEMA Trial
The INSEMA trial showed that for early stage, T1-T2 clinically node negative breast cancer, sentinel lymph node biopsies should not be mandatory, and best clinical judgement can be used.
Imlunestrant with or without Abemaciclib in Advanced Breast Cancer
Imlunestrant (novel oral SERD) was active in patients with an ESR1 mutations, but otherwise did not offer a benefit in this population of women with ER+ HER2-neg MBC. Overall survival (OS) data is pending with further follow up.
Camrelizumab vs Placebo in Combination With Chemotherapy as Neoadjuvant Treatment in Patients With Early or Locally Advanced Triple-Negative Breast Cancer
Another trial with neoadjuvant immunotherapy showing improved results over chemotherapy alone. (12% higher PCR 48% vs 36%).
Datopotamab Deruxtecan Versus Chemotherapy in Previously Treated Inoperable/Metastatic Hormone Receptor–Positive Human Epidermal Growth Factor Receptor 2–Negative Breast Cancer: Primary Results From TROPION-Breast01
Dato-DXd is now approved in HR+, HER2-neg, metastatic breast cancer after prior therapy with endocrine-based therapy and chemotherapy. There was an impressive reduction in the risk of death or progression with an HR of 0.63. Watch out for ocular and pulmonary toxicity. HER2-ultra low testing will be burdensome but must be done for drug approval.
